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Agreement between dementia patient report and proxy reports using the Nottingham Health Profile
- Authors:
- BOYER F., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1026-1034.
- Publisher:
- Wiley
The aim of the study was to examine the agreement between patient reports and their proxy reports (family and care provider proxies) on Health Status in a sample of patients with dementia. Completion rates for the different NHP dimensions ranged from 78 to 90% for the dementia subjects. Inter-rater agreement between different proxies and subject was from moderate to good for physical assessment (ICCs from 0.54 to 0.78 for physical mobility scales). Patient/family proxy concordance was moderate to good for five out of six dimensions (physical mobility, social isolation, pain, energy, sleep) and poor for emotional reaction. Family proxies systematically reported lower functioning than did patients in the four subscales assessing: physical mobility (p < 0.0001), energy (p < 0.005), social isolation (p < 0.01) and sleep (p < 0.03). Care provider proxies only estimated physical mobility as lower (p < 0.0001). Age and physical status of the patient significantly affected agreement in patient-care provider proxy ratings. Thus, caution is appropriate when resorting to proxies to estimate the Health Status of a dementia patient.
Vascular disease/risk and late-life depression in a Korean community population
- Authors:
- KIM Jae-Min, et al
- Journal article citation:
- British Journal of Psychiatry, 185(8), August 2004, pp.102-107.
- Publisher:
- Cambridge University Press
Associations between vascular risk factors and late-life depression are controversial. The aim was to investigate the association between measures of vascular disease/risk and depression and confounding and effect modification by APOE genotype and cognitive function. In a Korean community population aged 65+ (n=732), diagnosis of depression (Geriatric Mental State Schedule) and information on vascular status, disability, APOE genotype and cognitive function were obtained. Previous stroke and lower high-densitylipoprotein cholesterol level (but neither hypertension nor diabetes) were significantly associated with depression (independently of disability and cognitive function). These associations were stronger in participants with borderline cognitive impairment, although not to a significant extent. Except for previous stroke and an atherogenic lipid profile, associations between depression and other common risk factors for cerebrovascular disease were not evident.
Depression in frail elders: impact on family caregivers
- Authors:
- SEWITCH Maida J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.655-665.
- Publisher:
- Wiley
A cross-sectional study of 193 family caregivers of seniors treated in the emergency department (ED) was conducted. Measures included patient depression (Geriatric Depression Scale - 15), and caregivers' hours of care, mental health and physical functioning (SF-36), and quality of life (EQ-5D). Mean caregiver age was 60.0 ± 16.1 years and 70.5% were female. More caregivers of depressed seniors provided more care in the previous month (37.3% vs 22.4%, p = 0.03), had poor mental health (63.5% vs 47.0%, p = 0.03), and poor perceived quality of life (63.5% vs 50.4%, p = 0.04) compared to caregivers of non-depressed seniors. Multiple logistic regression analyses indicated that patient depression was associated with poor caregiver quality of life (OR = 3.15, 95% CI 1.48, 6.73), and poor mental health in spousal and adult child caregivers (OR = 2.72, 95% CI = 0.88, 8.39, and OR = 3.29, 95% CI = 1.10, 9.86, respectively). Psychosocial support may be needed for caregivers of depressed seniors.
Older women's cognitive and affective response to moderate drinking
- Authors:
- ZIMMERMAN Teena, MacDOUGALL Graham J., BECKER Heather
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1095-1102.
- Publisher:
- Wiley
In this paper the authors investigated the question, how do older women who drink moderate amounts of alcohol differ from those who do not drink on measurements of cognitive function, memory, affect and health? The nonprobability sample of female participants (n = 182) averaged 75 years of age and had a Mini Mental State Examination scores of 28. The participants were asked to indicate whether they drank alcohol or abstained (yes/no) and if they indicated that they did drink, to describe how many drinks they consumed in a given period of time (day/week/month). None of the participants acknowledged drinking more than 2 drinks a day. Caucasian women had the largest number of moderate drinkers (53% vs 47%), while the majority of African-American and Hispanic women reported not drinking. The moderate drinkers reported less depression, had higher self-reported health, performed better on instrumental everyday tasks, had stronger memory self-efficacy, and used more strategies to improve memory performance. In addition, these women had higher performance on tests of executive function: attention, concentration, psychomotor skills, verbal-associative capacities, and oral fluency. The circumstances under which people drink are complex and were not evaluated in this study. Therefore, rather than endorsing drinking behavior, these findings suggest that future research might examine why elders make the decision to drink, the circumstances that predispose women to drink (alone/with others), and other qualities that characterize female drinkers over the age of 65.
Family functioning in the caregivers of patients with dementia
- Authors:
- HERU Alison M., RYAN Christine E., IQBAL Asma
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.533-537.
- Publisher:
- Wiley
Caregiver burden has been extensively studied in the dementia population. The marital relationship has been suggested as a mediational model through which variables influence the caregiver and contribute to the experience of burden or reward. This study examines family functioning, caregiver burden and reward and quality of life in 38 family members caring for a relative with dementia. Caregivers of out-patients with dementia completed self report questionnaires. 63% of caregivers were female with a mean age of 62 years. Patient mean age was 73 years. The average number of caregiving years was 3.1. Caregivers were more likely to be spouses (61%) than children (29%) or other relatives (11%). Despite the fact that caregivers reported that their relatives were moderately disabled, they perceived more reward than burden. Caregivers who reported poor family functioning had higher ratings of strain and burden. Family functioning in these caregivers was poorest in the dimensions of affective responsiveness, problem solving and communication but it was also impaired in roles and affective involvement.
What causes problems in Alzheimer's disease: attributions by caregivers. a qualitative study
- Authors:
- PATON Joni, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.527-532.
- Publisher:
- Wiley
The aim was to gain insight into caregivers' understanding of the causes of behaviours they find problematic in people with Alzheimer's disease in order to inform the development of educational strategies. A qualitative, semi-structured interview was used. Participants were 205 caregivers for a person with Alzheimer's disease, all of whom were aware of the diagnosis and who had been recruited as part of a larger longitudinal study. Participants were from inner-city and suburban London/semi-rural Essex. The main outcome measures were caregivers' understanding of: the cause of problematic behaviour; the ability of the person with dementia to control this behaviour; the prognosis of the illness. Most carers attribute the cognitive, behavioural and psychological symptoms of dementia to causes other than dementia; many believe that the person with dementia has control over their behaviour and substantial numbers believe the person with dementia will return to normal. This study suggests that providing facts about the illness to caregivers is not enough, as caregivers may not understand that the symptoms they observe are related to the diagnosis. Education by clinicians should focus on the understanding of caregivers and in particular explore the caregivers' attributions of the symptoms which are present in the person for whom they care.
Associations between behaviour disorders and health status among older adults with intellectual disability
- Authors:
- DAVIDSON P. W., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.424-430.
- Publisher:
- Taylor and Francis
Few studies have examined the relationship of behaviour and health status among aging persons with intellectual and developmental disabilities (I/DD). Behavioural disorders, which often are coincident with functional decline in older persons with I/DD, may be more related to medical morbidity than previously reported. This cross-sectional study examined the association between health status and behaviour disorders with increasing age in a cohort of 60,752 adults with I/DD clustered into four adult-age groupings (21-44, 45-59, 60-74, and >74). Age grouping data suggested an association between morbidity and increased likelihood of behaviour symptoms in all but the oldest age grouping. The magnitude of the association and trend varied by specific disease across age groupings compared to that found in healthy cohorts. About 25% of the adults with I/DD had psychiatric diagnoses and the frequency of such diagnoses did not decrease with age grouping. These results suggest that adverse health status may increase the likelihood of persistent behavioural disturbances in older persons with I/DD. Moreover, behavioural disorders may be sentinels for occult medical morbidity, which in turn may be responsive to intervention.
Geriatric depression in Nigerian primary care attendees
- Authors:
- SOKOYA Olukunle, BAIYEWU Olusegun
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.506-510.
- Publisher:
- Wiley
202 older people were screened using the Geriatric Depression Scale (GDS). The Geriatric Mental State schedule (GMS) was administered to participants who scored above the cut-off on the GDS in order to assess psychopathology. Diagnosis of depression was based on ICD-10 criteria as well as the GMS-AGECAT programme. The rate of geriatric depression in primary care was found to be 7.4%. Severe depression was only 1.5%. Very low income and subjective report of poor health were significantly associated with depression in the cohort. AGECAT recognition of depression was comparable to that by the ICD-10 (k = 0.7). The study is the first known study of geriatric depression in primary care in Nigeria. The rates are comparable with rates obtained in other countries. Specific correlates of depression in the older Nigerians identified included poor self-assessed health and low income.
Bright light treatment improves sleep in institutionalised elderly: an open trial
- Authors:
- FETVEIT Arne, SKJERVE Arvid, BJORRVATIN Bjorn
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.520-526.
- Publisher:
- Wiley
This study evaluates the effects of bright light therapy among demented nursing home patients with sleep disturbances. 11 nursing home patients with actigraphically measured sleep efficiency below 85% took part in an open, non-randomised study where the subjects served as their own control. After two weeks of baseline measurements and two weeks of pretreatment measurements, patients received bright light exposure 2 h/day within the period 08:00-11:00 for two weeks. Sleep-wake patterns during the 24-h day were evaluated by nursing staff ratings and wrist-worn motor activity devices (actigraphs). Sleep improved substantially with bright light exposure. Waking time within nocturnal sleep was reduced by nearly two h, and sleep efficiency improved from 73% to 86%. Corresponding improvements were found in nursing staff ratings. Effects were consistent across subjects. The findings add further evidence of the effectiveness of morning bright light exposure in the treatment of disturbed sleep among demented nursing home patients
Care needs of elderly people with schizophrenia: assessment of an epidemiologically defined cohort in Scotland
- Authors:
- McNULTY Seamus V., et al
- Journal article citation:
- British Journal of Psychiatry, 182(3), March 2003, pp.241-247.
- Publisher:
- Cambridge University Press
Little is known of the needs of elderly patients with psychotic illnesses. The aim of this artilce was to measure the care needs of an epidemiologically based group of patients over the age of 65 years suffering from psychotic illness, using a standardised assessment. All patients aged 65 years and over with a diagnosis of schizophrenia and related disorders from a defined catchment area were identified. Their health and social care needs were investigated using the Cardinal Needs Schedule. The 1-year prevalence of schizophrenia and related disorders was 4.44 per 1000 of the population at risk. There were high levels of unmet need for many patients, including those in National Health Service (NHS) continuing-care beds. Many needs were identified, all of which could be addressed using the existing skills of local health and social care professionals. The investigation raises serious concerns about standards of hospital and community care for elderly patients with schizophrenia. The findings may be unique, reflecting long-standing problems within a particularly hard-pressed part of the NHS. However, it is not known whether a similar situation exists in other parts of the UK.